Posts Tagged ‘Cardiology Practice Consulting’

Ambulatory Surgery Centers (ASC) are busy – really, really busy. And yet one of the most time consuming processes is essential to their business – gaining ASC Medicare Certification through either AAAHC or AAAASF, whichever is most appropriate to their ASC. Working with experienced medical practice consultants who have deep experience with ASC Development is key, as the case study below indicates. Plus, this ASC took the opportunity to eliminate waste in workflow and improve overall operations.

Accreditation & Improved Workflow Processes make Clinic Vision a Reality
A local multi-clinic Eye Surgery Group with Ambulatory Surgery Centers (ASC) engaged us to help weigh the choices for accreditation, as well as for project management and oversight for the certification process. We worked with the ASC practice on the development and implementation of the chosen AAAASF Accreditation, including creation of policies, procedures and conducting a mock survey. Additionally, our ASC staffing redesign resulted in a projected $270,000 annual savings.
Phase I

• Review of accreditation standards for comparison to the client’s exiting Medicare (DOH) Certified ASC facility, as well as current operational policies and procedures, governing body documents, personnel policies, OSHA standards and Fire and Safety procedures.
• Assisted in the Functional Program and Facility physical layout design.

Phase II

DNA’s engagement continued in order to help coordinate completion of the required initial application documentation and ready the ASCs prior to the Accreditation site visit.
• Facilitated weekly leadership meetings to review progress and assign tasks. DNA also participated in the ASC facility design and safety requirements, including meeting with the DOH representative.
• DNA’s Certified Coder worked closely with the coding department, verifying and updating the ASC’s retinal fee schedules, facility and professional codes.
• Conducted mock survey site review for readiness prior to the survey visit. Clinic passed Accreditation after the initial site survey visit.

Phase III

The Medical Director requested that DNA conduct an operational assessment at designated ASC sites that would provide insight into patient flow, support staffing model and RN resource allocation. Recommendations were:
• Align Medical Assistants with appropriate tasks, freeing RNs to clinical focus.
• Assign RNs work that used their clinical, rather than administrative, skill set.
• Use a Just-in-Time (JIT) supply ordering methodology to improve space utilization as well as cash flow.

Results
Cost savings due to staffing model adjustments provided a cost-decrease of $8-10 per hour per FTE. Benefits included, savings totaled approximately $43-54,000 annually for a single ASC. Standardization of the proposed care delivery system throughout the four ASCs could approximate annual savings as high as $270,000.

The Eye Surgery Clinic stands as a proactive example of an organization ensuring their investments were solid and well-founded. Stakeholder decision-making had accurate, well-researched assumptions of volume and net revenue to rely on. The medical practice as a whole retains a sustainable position for cost-cutting due to initiatives undertaken during the Accreditation process. Natural attrition will allow continuation of staffing redesign, leaving the right staff doing the right work in the right amount of time.

Our clients are the best! See what another ASC client had to say about Derry, Nolan & Associates:

“I love my new ASC. The practice, office, and operating room space were flawlessly developed and managed by the team at Derry Nolan. Without them, I would not have arrived at this splendid practice setting.”— Dr. Dan Downey,
Downey Plastic Surgery

Physicians are feeling the pain and frustration of lowering Medicare reimbursements, increased malpractice insurance costs, new patient influx on the decrease, and rising overhead. In the meantime, physician compensation is lower. And by the way, the staff would like annual raises. It’s enough to drive physicians and their medical practices nuts!

But, there is a method to relieve those frustrations, as the case study synopsis below shows.

Medical Practice Efficiency: Case Study
We recently completed a long-term engagement with a multi-specialty medical practice. Their situation will probably sound familiar to many of you:

• Multiple service delivery locations – some doing well, some not so much
• Flat revenue vs. climbing expenses (rent, staff, lab, inventory)

Their goals (ambitious, but do-able) were to:

1. Reduce Costs
2. Increase Revenues
3. Increase Efficiency
4. Improve Patient Satisfaction
5. Improve Staff Satisfaction

We began with a medical practice operational and financial assessment, to measure cost structures, service lines, governance and related operations. From there, we were able to implement process improvements that led to millions – yes, millions of dollars in savings.

Waste can kill a medical practice – just look at our overall healthcare system inefficiencies:

• Paper-based systems accounts for 6% of annual overspending
• Administrative inefficiency and redundant paperwork accounts for 18% of healthcare waste
• Billing and administration take up one-quarter of the average US hospital budget
• US doctors spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor*

Approach and Results
Our approach with the multi-specialty practice was to eliminate non-value added work to achieve better patient, provider and staff satisfaction while increasing revenue opportunities. In other words, implement our mantra: “have the right people doing the right work in the right amount of time for the right pay.”

Using Lean principles (and MGMA cost data benchmarks), we benchmarked costs, redesigned processes, helped with organizational restructure (including executive leadership changes) and implemented new policies. You can find details in the presentation on our website’s media section, but the final results were:

• $3.8 million saved in expenses!
• Increased physician compensation
• Increased lab and imaging profitability
• Improved morale

We’re proud to report that the organization has sustained the improvement gains. Plus, they continue to benchmark and raise the bar with ongoing waste reduction efforts!

Snippet:
“Efficiency is integral to a more cost effective, productive medical practice.” — Barbara Derry & Crystal Nolan

Download the presentation that inspired this blog.

*healthcare inefficiency statistics taken from a report by Robert Kelley, vice president of healthcare analytics at Thomson Reuters.

Marketing is one of the biggest challenges a budding entrepreneur faces. One of the first rules is to make sure everyone you know is aware of what you’re doing. So when we began Derry, Nolan & Associates Medical Practice Consulting Services in 2003, our first step was to tell everyone we knew in the healthcare and medical field. After years in healthcare and being members of professional associations such as the Washington State Medical Group Managers Association (WSMGMA), that added up to a lot of breakfasts, lunches and dinners (Crystal gained 12 pounds)!

Next, realizing that a physician or medical practice group would likely contact their attorney or accountant if they were having financial issues or needed temporary practice management, we began visiting area firms. We set out to “wow” them with our LEAN training, our years of experience and of course, our bubbly personalities! Barbara went kicking and screaming – she did not like talking about herself. Crystal, being gregarious and a natural marketer, pulled her along.

Three months later, the phone began ringing and hasn’t stopped yet. Sure, there are days of no calls and we don’t land every prospective client, but we’re established and proven as a healthcare medical practice consulting firm. In fact, Derry, Nolan & Associates’ results-driven reputation is known in not only Washington, but also Oregon, Alaska and Montana.

Our marketing efforts continue to evolve with the times. We advertise our medical practice consulting services on industry-related websites, such as WSMGMA and Pierce County Medical Association’s Physician Directory. We present educational seminars at specialty medical practice and industry conferences. We write and publish many articles in medical journals such as King County Medical Society’s The Bulletin and the multi-state healthcare publication, Washington Healthcare News.

Most recently, we took the deep dive into social media with this blog. Plus you can find us on Facebook and follow us on Twitter!

That said, the best advertising remains word-of-mouth, for which we are very grateful to our many clients and colleagues who consistently recommend us to others!

Snippet
“Nobody becomes visible or in-demand by keeping quiet.” — Crystal Nolan

Get free consulting! Derry, Nolan & Associates’ offers a free, one-hour initial healthcare medical practice consultation.

Remember in our first blog entry, we told you that one part of our blog is about being true to yourself and taking risks? It’s part of being a successful entrepreneur. Well, some of our setbacks, and successes, are attributable to very personal stories that led us to quit our jobs and pursue the dream of owning our own business.

In 2002, hit with serious health issues, as well as personal loss, we each took a step back to re-examine our lives and reconsider our careers. Barbara, dealing with the stress of ever-increasing responsibilities in a new position and new boss stress, learned she had “pre” breast cancer. After a painful stereotactic breast biopsy, surgery and several months’ regimen of Tamoxifin, she was miserable. Severe hot flashes, depression, anxiety and loss of concentration – all supported her breast oncologist’s very clear message: If you want to prevent getting breast cancer, you need to remove the major stressor in your life. When leaving her doctor’s office one day, her husband turned to her and said, “Barb, you make a great salary, but no job is worth your life. I think it’s time you start your own business.” That was seven years ago, and Barbara has had no further episode.

Around the same time, Crystal’s right leg began swelling to the point she could barely walk, plus she was having chest pain and difficulty breathing. Unknown to her, a life-threatening deep vein thrombosis and pulmonary embolism was brewing. Told there was a very real possibility she would not survive more than 48 hours, she was hospitalized for a week, but all she could think of was relieving the excruciating pain. Both sons were called to her side, one flown in by naval aircraft carrier. When released, instead of resuming her customary healthy lifestyle, she went to months of doctor’s appointments, strictly monitored Coumadin levels, and dealt with chronic leg swelling. So when her younger brother, dying of lung cancer, told her that “people who don’t take risks, don’t have shit!” she listened.

Very scary incidences paired with heartfelt advice from loved ones. What more catalyst did we need? So in March 2003, Derry, Nolan & Associates, Healthcare Medical Practice Consulting Services, became a reality. We’ve never looked back.

Today, our client list includes Oncology, Cardiology, Multi-specialty, Family Practice, and Plastic Surgery Clinics, as well as Ambulatory Surgery Centers. We use a structured, consultative approach to eliminate waste, help clients become more profitable, more flexible in scheduling, and most importantly, happy in their daily work. Knowing how invaluable family time is, we help providers get home at a reasonable hour – that’s much more important than dictation or paperwork. Sometimes (one of our favorite roles) we act as healthcare interim executives and help healthcare organizations as they recruit for a permanent replacement.

In seven years of healthcare medical practice consulting, we learned to cherish our freedom to be creative, to laugh, to mentor others, and to help ensure our clients have the right people, doing the right work, in the right amount of time. We also learned – and take this to heart – never settle for less than your full potential!

Next time…our approach to marketing and how we launched Derry, Nolan & Associates!

Want to raise eyebrows? Advise a physician or medical practice that they’ll be paying to update, or implement, their compliance program. As medical practice consultants, we frequently discover that our healthcare and medical consulting clients need to update their compliance program. Here’s an anecdote “from the trenches” that demonstrates how consternation can turn to understanding.

Recently, Barbara Derry presented a proposal to a specialty group. Afterwards, one physician chastised her, feeling that our fees were too high for a coding and documentation audit. She left thinking that DNA wouldn’t win the project. Imagine our surprise when the practice not only hired us for the project, but also added compliance program redesign to the engagement’s scope. To top it off, they paid us in full by year-end!

The Office of Inspector General (OIG) and CMS dictates the guidelines that medical practices and other healthcare organizations must follow related to governance, coding and billing practices, and auditing and monitoring reporting structures. Some providers object, but there is no denying that rampant fraudulent billing occurs nationwide – particularly in the four test states (Florida, California, Texas and New York) of the 2005-2008 Recovery Audit Contractors (RAC) demonstration program. An effective compliance program can help avoid fraudulent billing.

How can you tell if your healthcare organization’s compliance program is effective? Here are common areas that DNA examines:

• Organizational behavior: Is the business philosophy compliance-driven? How is employee awareness and support? Physician compliance? Overall compliance program credibility?
• Compliance Awareness: What is the overall employee awareness of your compliance program? Its policies and activities?
• Oversight and response: What’s the activity level of the compliance officer and management in the regulatory process? Disciplinary consistency? Discovery and investigation? Error documentation? Employee satisfaction?
• Education Program: How many employees are educated, how often, and what are standard attendance percentages?
• Coding and claims accuracy: How well does the practice audit and monitor findings, such as coding and documentation errors, claim errors and claim rejection/denial percentages?
• Coding and claims processes: How many services are un-billable due to poor coding practices? How many claims are processed and properly use charge master and coding/claim technology?
• Corrective action: How usable and accessible are reporting mechanisms? What’s the interaction with carriers and intermediaries? How efficiently are reported concerns resolved?
• Quality Improvement Program: How responsive and adaptive is it to industry and regulatory changes? Does it efficiently distribute information? How is the business and financial success of the practice?

The OIG is very busy, determined to curb fraudulent billing practices and recuperate monies paid incorrectly over the past several years. There are literally hundreds of healthcare providers now under corporate integrity agreements (CIAs) that last five years. If a healthcare organization is under a CIA with the OIG, it means they must closely follow specified methods and activities that ensure they meet statutory and regulatory standards, and report properly. Discover the targeted areas at http://oig.hhs.gov/fraud/cias.asp.

Our advice? Be ready; be in compliance.

DNA Snippet
The Obama Administration says that it is going to crack down on improper payments made by all government programs, which in 2009 totaled $98 billion according to federal agency estimates. (GovernmentExecutive.com)

For help assessing or updating your medical practice’s compliance program, contact Derry, Nolan & Associates.

Webster’s dictionary says benchmarking is “a standard by which something can be measured or judged.” In a recent post, we mentioned the need to use the right yardstick to measure patient loyalty. Benchmarking is one of the best tools to see how your medical practice stacks up against others in a similar specialty or size.

Blame it on Xerox Corporation – in addition to copiers, they began official benchmarking practices. Now, in addition to corporate America, medical practices, clinics, hospitals, and pretty much any healthcare organization uses benchmarking to compare processes (coding, overhead, staffing ratios, accounts receivable) with others in the same or similar specialty. Using such high performer comparisons helps the medical profession raise the bar for best practices.

Why is it important? Quite simply, benchmarking provides a structured approach to data gathering and analysis. It helps you, in practice/clinic management, to develop the best strategies, and points you in the direction of the best operational decisions, too. Because it quantifies the measures of performance, medical practices are able to truly measure the gap between their own organization and “best practices,” not to mention competitors. Best of all, knowing what you’re up against encourages creative thinking and stimulates innovation.

To benchmark, follow these steps:

1. Identify the problem – do you want to lower overhead? Increase collections?
2. Determine areas for attention – staffing ratios, 120-day A/R
3. Obtain buy-in from decision-makers
4. Know how you do things now, so you know what needs to change/improve
5. Compare to peer groups
6. Gather accurate data
7. Communicate the improvement action plan
8. Develop dashboard indicators and continuously measure against them!

Start with realistic goals – like reducing patient wait time by 15 minutes or introducing Just-in-Time ordering to reduce overstocked inventory. And benchmark based on factors that relate to cost, quality and timeliness – internal factors. Monitor and re-evaluate at set intervals so Continuous Quality Improvement becomes the culture.

Above all, remember: Benchmarking is not a one-time event but a continuum.

DNA Snippet
For the complete presentation of “Why Benchmark?” given by Crystal Nolan at the WA-OR MGMA meeting in 2009, visit the Derry, Nolan & Associates website.

Have you been thinking about a Patient or Employee Survey for your medical practice? Great idea! But be sure you’re measuring what counts and why. Just logging a score of 5 out of 5 isn’t enough.

In If Disney Ran Your Hospital, author Fred Lee points out that competing for the best numbers because there are bonuses tied to their rankings is a recipe for disaster. Why? Because it sends managers the message that a high score is more important than honest feedback. Even if a healthcare organization pushes patients to tell staff how to improve enough to earn the high marks, they’re still not getting the real picture.

What a medical practice or any healthcare-related business needs to know is the percentage of loyal patients who will promote the business. As we’ve said before, meeting expectations isn’t enough – it’s the unique, the special, experience that generates feelings of loyalty.

Yes, world class organizations like Disney count only the “5s” but they don’t make those numbers say anything other than “very satisfied” on a scale that has two other numbers for those who are merely “satisfied.” That’s because they do not want to combine loyal customers with satisfied but not loyal customers – after all, satisfied customers still defect! Instead, Disney genuinely tries to measure loyalty, not satisfaction.

Customer loyalty authority Frederick Reichheld purports to have found the ideal yardstick with which to determine customer and employee loyalty after researching 14 companies across six industries. What do you think it is?

Well, in this brave new world of social media, the answer should come as no surprise – “How would you recommend [our medical practice, our company] to a friend or colleague?” His scale says 10 means “extremely likely” to recommend (Promoter), 5 means neutral and 0 means “not at all likely” (Passive and Detractor ranges).

Simple, intuitive and reliable as a predictor – the personal recommendation. We all want to have Promoters in our corner, right? Plus, frontline managers (practice managers, administrators) gain a clear goal to increase the number of Promoters and reduce Detractors. So when developing that upcoming survey, think “loyalty” not “satisfaction.”

Remember, Facebook, Yelp, RateMDs, PhysicianReports, and a plethora of other free, online sources already let your patients (and employees) speak up – are you ready to listen?

DNA Snippet

“Measure to improve, not to impress.” — Fred Lee, author

Visit derrynolan.com to learn more about our medical practice consulting services.

Things are changing in 2010 and our Oncology coding expert, Derry, Nolan & Associates’ medical practice consultant Gwen Davis, CPC, put together a few tips for our Oncology medical practice clients. It’s a good Evaluation and Management coding guidelines hotlist, so read on. Then, see today’s DNA Snippet for resources regarding Medicare Consults in 2010.

Manage Your Documentation (think EMR, Fee Tickets, MAR, Flowsheets & Coding)

• Keep updated tools and databases current
• Provide ongoing education to billing as well as clinical staff
• Hire certified coders and ensure regular interactions with physicians

Time-Based Billing Accuracy
Routinely, Oncologists have intense, sensitive “Life and Death” counseling sessions with patients and family members. For correct time-based billing, remember the following:

• More than 50% of the time you’re with a patient must be spent on counseling or coordination of care
• Face to face time counts, ancillary service provider time doesn’t – such as when a nurse is drawing blood. Also, should you leave Patient A to go check on Patient B and then return to Patient A, the time out-of-room does not count as Patient A time.
• Document clearly the time you spent and what was discussed, ensuring it is plausible and accounts for time claimed. No “cloning” from a previous patient or simple pasting of a generic statement about drugs and side effects, or using a blanket “spent 30 minutes counseling patient” statement.
  Suitable Documentation Example: Patient was here for 50 minutes; 30 minutes consisted of face-to-face counseling on end of life issues regarding his current diagnosis X, treatment options X, and side effects. Additional counseling discussing lifestyle changes (hospice, long term care) also took place.

Oncology Reimbursement Recommendations
Gwen mentions the importance of documentation as related to Oncology reimbursement and its associated regulations, “I routinely navigate complex regulations regarding expensive chemotherapy treatments. Right now, I’m developing tools that will help Oncology offices with the 2010 RAC and OIG regulations.” (Thanks, Gwen!) Her five quick recommendations are:

1. Know current FDA Indications (use the compendia!)
2. Document when you are going Off Label
3. Know current billing requirements
4. Watch those HCPCS Units
5. And finally, let your computer work for you. Flag your system to catch medically unlikely charges and work these audits prior to submitting claims. It will save time, money and headaches!

Understanding and Following Incident-to Requirements
This “last but not least” recommendation regarding documentation is about Incident-to criteria. Be sure to identify who rendered the service and that the direct supervision requirement was met. Show the physician’s initiation and continued involvement in the treatment, as well as showing that the services are reasonable and necessary. And be sure to show that the services are within the scope of practice for the non-physician practitioner.

Remember, correct documentation is the key to successful reimbursement!

DNA Snippet
Visit the Practice Resource Center at www.wsma.org for helpful guidelines to navigating Medicare Consults in 2010. Plus, the WSMA’s Coding Hotline gives great guidance on CPT, ICD-9 and HCPCS coding. Just call Michelle Lott, CPC at 1-800-552-0612.